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the online version of this article abjs.mums.ac.ir
Arch Bone Joint Surg. 2014;2(1): 84-85. http://abjs.mums.ac.ir
Dear Editor
We read the article by Bagheri et al with great interest
(1). We found the study interesting and comprehensive as four groups of patients, including operative and nonoperative in either pure dislocation or fracture dislocation, were compared in terms of Mayo wrist score, Grip strength, range of motion and radiographic parameters. It seems that the results were comparable
to studies by Capo, Chou, Laporte, Malovic, Kremer, Forli and Lutz (Table 1) (2-8).
In the studies listed above, all the patients were
treated by operative fixation and none of them reported any experience with non-operative treatment (2-8).
Their operative results are almost similar to Bagheri’s operative results in which they demonstrated better outcomes in terms of motion and Mayo score than the
LETTER TO THE EDITOR
Benefits of Either Operative or Non-Operative
Treatment for Perilunate Dislocation and Fracture
Dislocations
Table 1. studies around the world on the results of operative treatment after perilunate dislocation (PLD) and perilunate fracture dislo-cation (PLFD)
Authors Year Country Op. vs.
Non-op No. of patients
Average F/U
Mayo score
PRWE
score
DASH score DJD
Arc of
flex-ext
Grip strength
Bagheri et al (1) 2013 Iran
Non-op PLD 5 70.32 m 71 2 98.1°
Non-op PLFD 9 69 m 71.1 3 96.6°
Op. PLD 6 62.4 m 85 3 101.66°
Op. PLFD 14 65.4 m 87.7 4 109.28°
Capo et al (2) 2012 NJ, USA Op. PLD 13 6 m< 40/100 13 86° 59%
Op. PLFD 12 78°
Chou et al (3) 2012 Taiwan Op. PLFD 24 45 m 83 144° 84%
Laporte et al (4) 2012 France Op. PLD 6 26 m 41 24.6/55 101° 71%
Op. PLFD 11
Malovic et al (5) 2011 Croatia Op. PLFD 43 29 m 87
Kremer et al (6) 2010 Germany Op. PLD 9 66 m 70 20 77° 70%
Op. PLFD 30
Forli et al (7) 2010 France Op. PLD 11 13 y 77 13 8 94° 87%
Op. PLFD 7 13 y 74 35 4 98° 87%
Lutz et al (8) 2009 Austeria Op. PLD 15 5 y 81.5 20.7 80-85%
Op. PLFD 10 5 y 82.7 27.7
THE ARCHIVES OF BONE AND JOINT SURGERY. ABJS.MUMS.AC.IR VOLUME 2. NUMBER 1. MARCH 2014
)85(
LETTER TO THE EDITOR
References
1. Bagheri F, Taraz-Jamshidi M, Birjandinejad A,
Shari-fi-Daloei SR, Mirkazmi M, Fathi-Choghadeh M, et al.
Trans-scaphoid perilunate fracture-dislocation and isolated dislocations;surgical versus nonsurgical treatment. Arch Bone Joint Surg. 2013; 1(2):74-77 2. Capo JT, Corti SJ, Shamian B, Nourbakhsh A, Tan V,
Kaushal N, et al. Treatment of dorsal perilunate dis -locations and fracture-dis-locations using a
standard-ized protocol. Hand (N Y). 2012;7(4):380-7.
3. Chou YC, Hsu YH, Cheng CY, Wu CC. Percutaneous
screw and axial Kirschner wire fixation for acute
transscaphoid perilunate fracture dislocation. J Hand Surg Am. 2012;37(4):715-20.
4. Laporte M, Michot A, Choughri H, Abi-Chahla ML, Pe-lissier P. Perilunate dislocations and fracture-dislo-cations of the wrist, a review of 17 cases. Chir Main. 2012;31(2):62-70.
5. Malović M, Pavić R, Milosević M. Treatment of trans-scaphoid perilunate dislocations using a volar
ap-proach with scaphoid osteosynthesis and temporary
Kirschner wire fixation.Mil Med.
2011;176(9):1077-82.
6. Kremer T, Wendt M, Riedel K, Sauerbier M, Germann
G, Bickert B. Open reduction for perilunate
injuries--clinical outcome and patient satisfaction. J Hand Surg Am. 2010;35(10):1599-606.
7. Forli A, Courvoisier A, Wimsey S, Corcella D, Moutet F. Perilunate dislocations and transscaphoid peri-lunate fracture-dislocations: a retrospective study with minimum ten-year follow-up. J Hand Surg Am. 2010;35(1):62-8.
8. Lutz M, Arora R, Kammerlander C, Gabl M, Pechlan-er S. Stabilization of pPechlan-erilunate and transscaphoid perilunate fracture-dislocations via a combined
pal-mar and dorsal approach. Oper Orthop Traumatol.
2009;21(4-5):442-58. non-operative counterpart.
In the current study by Bagheri et al, non-operative
treatment is also discussed, which has little literature support so far (1). We wonder what the indications were leading the patient and the surgeon electing nonoperative treatment versus operative intervention. Since the outcomes of non-operative care were comparable to the operative outcomes, weighing the
benefits of non surgical management may be an area
of further investigation.The authors didn’t describe the
operative intervention in detail making comparisons with outer studies difficult. Therefore, we note the
need to compare different operative techniques in the
literature to figure out which provide the most optimal outcomes and expedite patients’ rehabilitation.
Michael Rivlin MD
Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
Amir Reza Kachooei MD
